<form action="<?php echo $this->getFormAction();?>" method="post">
<input type="hidden" name="type" value="2">
<input type="hidden" name="page" value="opportunity">
<table id="opportunity-left" width="100%">
	<tr class="sel-name">
		<td >
			<select name="title">
				<option value="1"><?php echo $this->__("Mr.");?></option>
				<option value="2"><?php echo $this->__("Mrs.");?></option>
				<option value="3"><?php echo $this->__("Miss");?></option>
			</select>
		</td>
		<td><input type="text" name="first_name" value="<?php echo $this->__("Your name");?>" onfocus="this.value=''"></td>
	</tr>
	<tr>		
		<td colspan="2"><input type="text" name="conpany_name" value="<?php echo $this->__("Company Name");?>" onfocus="this.value=''"></td>

	</tr>
	
	<tr>		
		<td colspan="2"><input type="text" name="conpany_address_01" value="<?php echo $this->__("Company Address Line 1");?>" onfocus="this.value=''"></td>

	</tr>
	
	<tr>		
		<td colspan="2"><input type="text" name="conpany_address_02" value="<?php echo $this->__("Company Address Line 2");?>" onfocus="this.value=''"></td>

	</tr>
	
	<tr>
		<td colspan="2"><select name="country"><option value=""><?php echo $this->__("Country of residence");?></option><?php echo $this->getCountryOptions();?></select></td>
	</tr>
	<tr>		
		<td colspan="2"><input type="text" name="business_nuture" value="<?php echo $this->__("Nature of business");?>" onfocus="this.value=''"></td>
	</tr>
	<tr>
		<td colspan="2"><select name="business_year"><option value=""><?php echo $this->__("Years in buniness");?></option><?php echo $this->getYearsBusinessOptions();?></select></td>
	</tr>
	
	<tr>		
		<td colspan="2"><input type="text" name="business_role" value="<?php echo $this->__("Your business role");?>" onfocus="this.value=''"></td>

	
	</tr>

</table>



<table id="opportunity-right" width="100%">
	<tr>

		<td><input type="text" name="email" value="<?php echo $this->__("Email address");?>" onfocus="this.value=''"></td>
	</tr>
	<tr>		
		<td><input type="text" name="tel" value="<?php echo $this->__("Contact telephone");?>" onfocus="this.value=''"></td>
	</tr>
	
	<tr>		

		<td><input type="text" name="subject" value="<?php echo $this->__("Message Subject");?>" onfocus="this.value=''"></td>
	</tr>
	
	<tr>		
		<td><textarea name="content"  class="opp_text" onfocus="this.value=''"><?php echo $this->__("Please type your message here.");?>
			</textarea></td>
	</tr>
	


	
	<tr>		
		<td align="right"><input type="submit" name="submit_button" value="<?php echo $this->__("Submit contact");?>" id="contact_submit"></td>
	
	</tr>

</table>

</form>
